The candidate is a cardiologist and junior health services researcher at University of California, Irvine. Her long-term goal is to develop an independent career as a researcher in preventive cardiology with a focus on applying new tools to prevent cardiovascular disease in those with diabetes and metabolic syndrome. The proposed five year training program includes didactic coursework, a Master's degree, and strong mentorship to provide training in patient-centered research, clinical trial design and novel uses of existing image data. The proposal has an overall aim of the candidate integrating her expertise in cardiovascular imaging with her interest in risk communication within the context of the patient doctor relationship. She will be mentored by Dr. Sherrie Kaplan an expert in patient-centered care and co-mentored by Dr. Sheldon Greenfield, an expert in the field of quality assessment and by Dr. Matthew Budoff who is an expert on cardiac CT imaging. Our proposed study goal is to understand how cardiovascular risk is communicated and how personalized risk information can motivate preventative behavior. We aim to: 1.) Determine how and with what frequency cardiovascular risk is communicated by primary care physicians to their patients with diabetes;2.) Develop and test a measure to capture physician-patient communication about cardiovascular risk;and 3.) Assess the effect of communicating cardiovascular risk with pre-existing cardiac CT angiogram images of coronary arteries and Framingham Risk Score (FRS) versus FRS only on patient understanding of risk, change in risk behavior, and risk factor reduction. Knowledge from the research portion of this training grant will form the basis of an RO1 application to test the hypothesis that images of subclinical disease can be effective in risk communication, particularly in patients with literacy, linguistic or cultural barriers. PUBLIC HEALTH RELEVANCE: Changing behavior to improve one's health is difficult. In this study, we are studying a new way to motivate patients with diabetes by using images to help them understand their disease. This may result in health behavior that could lessen the chances of heart disease in the future.